Provider Demographics
NPI:1376595660
Name:LORENZ, W DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:W
Middle Name:DEAN
Last Name:LORENZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E CHEVES ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2704
Mailing Address - Country:US
Mailing Address - Phone:843-661-4390
Mailing Address - Fax:843-629-7485
Practice Address - Street 1:900 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2704
Practice Address - Country:US
Practice Address - Phone:843-661-4390
Practice Address - Fax:843-629-7485
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17597208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00375523OtherMEDICARE RAILROAD
SCT16284Medicaid
SCP00375523OtherMEDICARE RAILROAD
SCF74193Medicare UPIN